APPOINTED STATE OFFICER

APPLICATION

Personal Information

Name:

Address:

City: State: Zip Code:

E-Mail: Cell #:

Birthdate: Age:

Education

Please list your current education level and what school you attend

School Name:

Field of Study: GPA:

Club: Office:

Club: Office:

Club: Office:

Automobile Information

Make: Model:

Color: Tag #:

Insurance Co.: Policy Holder

Policy #:

Driver’s License #:

1. Do you have a valid New Jersey Driver’s License? YES NO

2. If not, do you have someone able to provide you with a ride to DeMolay events? YES NO

APPOINTED STATE OFFICER

APPLICATION

DeMolay Experience

Chapter: Initiation Date:

Chapter Offices

Held:

State Offices Held:

Ritual Parts Known

– Not Included

Above (Flower

Talk, DeMolay

Degree,

Installation)

1. Have you attended a Leadership Training Conference? YES NO

2. What year(s) and conference(s)? ___________________________________________________

__________________________________________________________________________________

3. I have completed the following LCC’s: 1 2 3 4 5

Please note, LCC 1 &2 are a requirement to be considered for appointed office

4. Please list any other DeMolay Honors or Awards you have earned (Chevalier, PMC-MSA, Blue

Honor Key):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

5. I would like to be considered for the office of: RMC Chap. Mar. Other

APPOINTED STATE OFFICER

APPLICATION

Basic Expectations

I will be available to attend all assigned events.

I will be able to travel to various chapters, realizing I may be assigned to chapters across thestate, and that I will need to set aside time on weeknights to attend chapters, with a stronglikelihood of being out at least two nights a week.

I will perform all duties that are assigned to me by the New Jersey State Council, including by theState Master Councilor, and realize that everyone is working towards the goal of bettering NewJersey DeMolay. I also acknowledge that additional duties may appear as the year progressesthat will require my attendance, time, and efforts.

I will promptly respond to all communication within an appropriate amount of time including,but not limited to phone calls, e-mails, text messages, and snail mail.

I will in the event I cannot attend an event or perform a commitment, give advance notice to theState Master Councilor and will communicate with him to come up with a viable solution. Irealize that communication is a part of my duties as a State Elected Officer.

I realize that I must properly balance school, work, family, and life commitments aroundDeMolay. I realize that in the event I cannot meet basic requirements, the Executive Officerreserves the right to remove me from office at any time.

Do you agree to the following expectations? YES NO

Photo Release

I hereby grant the New Jersey DeMolay permission to use my likeness in a photograph, video, or other digital

media (“photo”) in any and all of its publications, including web-based publications, without payment or other

consideration.

I understand and agree that all photos will become the property of New Jersey DeMolay and will not be returned.

I hereby irrevocably authorize New Jersey DeMolay to edit, alter, copy, exhibit, publish, or distribute these photos

for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my

likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of

the photo.

I hereby hold harmless, release, and forever discharge the New Jersey DeMolay from all claims, demands, and

causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my

behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHIOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE,

OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS

AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT:

APPOINTED STATE OFFICER

APPLICATION

Requirements

I will perform all duties that are assigned to me by the New Jersey State Council, including bythe State Master Councilor, and realize that everyone is working towards the goal of betteringNew Jersey DeMolay. I also acknowledge that additional duties may appear as the yearprogresses that will require my attendance, time, and efforts.

I have completed my obligations, the Master Councilor’s Opening, Closing and Nine O’clockInterpolation, and any opening/closing work associated with the office for which I’m seekingappointment.

I have completed my first two Leadership Correspondence Courses and am actively workingon earning my Lamp of Knowledge.

I am actively working on completion of my Representative DeMolay, if I haven’t alreadyearned it.

Authorization:

______________________________________ ______________________________________

Applicant Signature Parent or Guardian Signature

______________________________________ ______________________________________

Chapter Chairman Signature Chapter DAD Signature

Please send your completed form to:

“Dad” Matthew Golway @ mgolway@gmail.com or via US Mail (email for address)

All forms must be submitted/postmarked no later than May 15th